Cervical Cancer Stages

After someone is diagnosed with cervical cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes the extent of the cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.

To determine the cancer’s stage after a cervical cancer diagnosis, doctors try to answer these questions:

How far has the cancer grown into the cervix?

Has the cancer reached nearby structures?

Has the cancer spread to the nearby lymph nodes or to distant organs?

Information from exams and tests is used to determine the size of the tumor, how deeply the tumor has invaded tissues in and around the cervix, and its spread to distant places (metastasis). For more information see Cancer Staging.

The FIGO (International Federation of Gynecology and Obstetrics) staging system is used most often for cancers of the female reproductive organs, including cervical cancer. For cervical cancer, the clinical stage is used and is based on the results of the doctor's physical exam, biopsies, imaging tests, and a few other tests that are done in some cases, such as cystoscopy and proctoscopy. It is not based on what is found during surgery. If surgery is done, a pathologic stage can be determined from the findings at surgery, but it does not change your clinical stage. Your treatment plan is based on the clinical stage.

The American Joint Committee on Cancer (AJCC) TNM staging system is another staging system based on 3 key pieces of information:

T describes how far the main (primary) tumor has grown into the cervix and whether it has grown into nearby tissues.

N indicates any cancer spread to lymph nodes near the cervix. Lymph nodes are bean-sized collections of immune system cells, to which cancers often spread first.

M indicates if the cancer has spread (metastasized) to distant sites, such as other organs or lymph nodes that are not near the cervix.

FIGO stages are the same as AJCC stages﻿.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.

Cervical cancer stage ranges from stages I (1) through IV (4).

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

Cervical cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand. (An explanation of the TNM and FIGO systems is in the stage table below.)

AJCC

Stage

Stage grouping

FIGO Stage

Stage description

I

T1

Any N

M0

I

The cancer cells have grown from the surface of the cervix into deeper tissues of the cervix. The cancer may also be growing into the body of the uterus, but it has not grown outside the uterus (T1).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IA

T1a

Any N

M0

IA

There is a very small amount of cancer, and it can be seen only under a microscope (T1a).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IA1

T1a1

Any N

M0

IA1

The area of cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide (T1a1).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IA2

T1a2

Any N

M0

IA2

The area of cancer invasion is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide (T1a2).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IB

T1b

Any N

M0

IB

This includes stage I cancers that can be seen without a microscope as well as cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into connective tissue of the cervix or are wider than 7 mm (T1b).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IB1

T1b

Any N

M0

IB1

The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches) (T1b1).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IB2

T1b2

Any N

M0

IB2

The cancer can be seen and is larger than 4 cm (T1b2).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

II

T2

Any N

M0

II

The cancer has grown beyond the cervix and uterus, but hasn't spread to the walls of the pelvis or the lower part of the vagina (T2).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IIA

T2a

Any N

M0

IIA

The cancer has not spread into the tissues next to the cervix (called the parametria) (T2a).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IIA1

T2a1

Any N

M0

IIA1

The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches) (T2a1).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IIA2

T2a2

Any N

M0

IIA2

The cancer can be seen and is larger than 4 cm(T2a2).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IIB

T2b

Any N

Mo

IIB

The cancer has spread into the tissues next to the cervix (the parametria) (T2b).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

III

T3

Any N

M0

III

The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder) (T3).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IIIA

T3a

Any N

M0

IIIA

The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder) (T3a).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IIIB

T3b

Any N

M0

IIIB

The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters causing kidney problems (called hydronephrosis) (T3b).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IVA

T4

Any N

M0

IVA

The cancer has spread to the bladder or rectum or it is growing out of the pelvis (T4).

It might or might not have not spread to nearby lymph nodes (Any N).

It has not spread to distant sites (M0).

IVB

Any T

Any N

M1

The cancer has spread to distant organs beyond the pelvic area, such as distant lymph nodes, lungs, bones or liver. (M1)

T categories for cervical cancer

The T category describes how far the main tumor has grown into the cervix or beyond.

The T categories are described in the table above, except for:

TX: Main tumor cannot be assessed due to lack of information

T0: No evidence of a primary tumor

N categories for cervical cancer

The N category describes spread only to the lymph nodes near the cervix. Spread to distant nodes is considered metastasis (described in the M category).

The N categories are described in the table above, except for:

NX: Regional lymph nodes cannot be assessed due to lack of information.